San Qi
StarPanax notoginseng (Burk.) F.H. Chen
Traditionally used for
- Menstrual & women's health
- Pain & joints
- Heart & circulation
- Energy & fatigue
Cautions & contraindications
- Pregnancy
- Bleeding disorders
- Before surgery
☯ TCM Properties
Dispels Stasis and Stops Bleeding; Invigorates Blood and Dispels Stasis; Reduces Swelling and Alleviates Pain
Traditional Chinese Uses
San Qi (notoginseng root, tienchi ginseng) is a warm, sweet-slightly-bitter herb considered one of the most important hemostatic herbs in Chinese medicine — with the unique property of stopping bleeding while simultaneously dispersing Blood stasis. This dual action makes it useful for bleeding from trauma where preventing clot formation is also important, such as in traumatic injuries with bruising and internal bleeding. It is also used for menstrual conditions from Blood stagnation and chest pain from coronary artery disease.
Western Herbalism Properties
Pharmacological Effects
- Effect on the blood: Powder or warm-water extract shortened rabbit coagulation time and stopped visceral bleeding; autoclaving abolished it; oral effect lost after portal vein ligation, suggesting liver involvement.
- Coronary dilation: IV saponins increased coronary flow in anesthetized dogs for 9.8-12 min; rootlet extract raised it up to 57% peaking at 2-3 h; direct action on vascular smooth muscle.
- Myocardial oxygen consumption and ischemia: IV 2.5% injection cut myocardial O2 consumption by 14.28% in dogs; extract normalised ST changes in ischemic rabbits; IV saponins protected against hemorrhagic shock.
- Hypotensive: Extract and total saponins produced prolonged hypotension in dogs and rabbits via vasodilation from inhibition of Ca2+ influx.
- Cardiac contractility and heart rate: Low concentrations increased contraction in isolated hearts; high concentrations suppressed contraction, slowed rate and caused AV block.
- Antiarrhythmic: Total and panaxatriol saponins active against chloroform, BaCl2, aconitine and epinephrine arrhythmias in mice, rats and rabbits.
- Antiinflammatory and analgesic: Total saponins antiinflammatory in mice and rats; IP leaf saponins analgesic in mice comparable to aminopyrine, faster but shorter than morphine; also sedative.
- Hepatocytic regeneration: SC total saponins inhibited CCl4-induced SGPT rise and increased liver DNA and protein synthesis in mice.
Source: Zhu YP. Chinese Materia Medica: Chemistry, Pharmacology and Applications. Harwood Academic, 1998, p. 423.
Relationships
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Botanical Description
Panax notoginseng (Burkill) F.H. Chen ex C.Y. Wu & K.M. Feng (Araliaceae), sometimes called Chinese ginseng or sanchi, is a perennial herb 30-60 cm tall arising from a stout, fleshy, conical to spindle-shaped taproot bearing concentric ring scars and several radiating lateral rootlets. The single erect stem carries a terminal whorl of three to four palmately compound leaves, each typically with five to seven oblanceolate, serrate leaflets. In summer a long-peduncled umbel of small, greenish-yellow flowers gives rise to a cluster of bright-red, kidney-shaped drupes that ripen from green. Native to mountainous regions of Yunnan and Guangxi provinces in southwestern China and now cultivated under shade there, the dried root (San Qi) is celebrated in TCM and modern Western phytotherapy chiefly to stop bleeding, dispel blood stasis, and relieve pain.
Active Constituents
Ginsenoside Rg1
Protopanaxatriol-type dammarane saponinConcentration: roughly 4 percent of the dried root (3.96-4.27 percent reported)
The single most abundant saponin in notoginseng root and, with Rb1 and notoginsenoside R1, one of the three markers used to standardise the drug and its extract Panax notoginseng saponins. It underlies the vasodilatory, anti-ischaemic and antiplatelet side of the herb's action, and is the reason a herb classified as a haemostatic can simultaneously behave as an antithrombotic.
Ginsenoside Rb1
Protopanaxadiol-type dammarane saponinConcentration: roughly 3.8 percent of the dried root (3.81-3.86 percent reported)
The principal protopanaxadiol saponin of the root. It is poorly absorbed intact and is largely deglycosylated by gut microbiota to compound K and related metabolites, which carry much of the systemic anti-inflammatory and neuroprotective activity attributed to the herb.
Notoginsenoside R1
Protopanaxatriol-type dammarane saponinConcentration: a minor saponin, of the order of 0.1 percent of the dried root
The saponin unique to Panax notoginseng among the commercial Panax species, which makes it the chemical marker that distinguishes San Qi from Ren Shen (Panax ginseng) and Xi Yang Shen (Panax quinquefolius). It contributes endothelial-protective and anti-inflammatory activity.
Ginsenoside Rd
Protopanaxadiol-type dammarane saponinConcentration: roughly 0.5-0.6 percent of the dried root
A minor saponin that is also a major circulating metabolite of Rb1. It is one of the five saponins quantified in the standardised Panax notoginseng saponins extract used in the Xuesaitong preparations studied in stroke trials.
Dencichine
Non-protein amino acid (beta-N-oxalyl-L-alpha,beta-diaminopropionic acid)Concentration: reported at around 0.9 percent of the root
The water-soluble amino acid credited with the haemostatic and platelet-raising half of San Qi's bidirectional action, and the reason raw powdered San Qi is used to stop bleeding while the saponin-rich extracts are used to move Blood. Practitioners should know that dencichine is chemically identical to beta-ODAP, the excitotoxic amino acid of grass pea (Lathyrus sativus) responsible for neurolathyrism; neurotoxicity in that setting follows months of grass pea as a staple food, and no neurolathyrism has been reported from medicinal notoginseng, but the identity is real and is why open-ended high-dose self-medication is not advisable.
⚠ Drug Interactions
Warfarin
Two rat studies report opposite directions and both are worth knowing. Qian and colleagues found that co-administered Panax notoginseng saponins raised prothrombin time by 110-126 percent and INR by 111-128 percent versus warfarin alone, cut warfarin clearance by up to 33 percent and raised AUC by up to 134 percent, with downregulation of CYP3A4 and no effect on CYP2C9. Yang and colleagues, prompted by clinical cases in which the combination appeared antagonistic, found the reverse: the saponins accelerated warfarin metabolism and reduced its effect by downregulating miR-214-3p, which de-represses NR1I3 (CAR) and raises CYP2C9. Warfarin is the drug whose main enantiomer is cleared by CYP2C9, so a CAR-driven CYP2C9 induction is a mechanistically plausible route to loss of anticoagulation, while CYP3A4 inhibition is a plausible route to over-anticoagulation. The net direction in any given patient is not predictable from the literature.
Clinical note: Do not treat this as a simple additive bleeding interaction. If San Qi is started, stopped or its dose changed in a warfarin patient, check INR within 3-7 days and again at 2 weeks, and keep monitoring until stable. Advise the patient not to take San Qi intermittently, since it is the changes rather than the steady state that destabilise INR.
Aspirin and other antiplatelet drugs (clopidogrel, ticagrelor)
A meta-analysis of randomised trials in coronary heart disease and ischaemic stroke found that Panax notoginseng saponins added to aspirin inhibited platelet aggregation significantly more than aspirin alone (WMD -6.10) and further reduced fibrinogen and D-dimer, while panaxatriol saponins plus aspirin additionally prolonged prothrombin time and PT-INR. In that pooled analysis there was no significant excess of positive faecal occult blood, upper gastrointestinal bleeding, subcutaneous haemorrhage, bulbar conjunctival haemorrhage or haematuria. The pharmacodynamic addition is real even though the trials did not detect harm; those trials excluded patients at high bleeding risk.
Clinical note: The combination is deliberate and common in Chinese cardiology practice and appears well tolerated at trial doses, but the antiplatelet effect is genuinely additive. Avoid stacking it on dual antiplatelet therapy, on anticoagulation, or in patients with peptic ulcer, thrombocytopenia or recent intracranial bleeding, and stop it before surgery.
Gynura japonica or Gynura segetum (Tu San Qi) supplied or self-selected as San Qi
Tu San Qi is the name given to Gynura japonica and related Asteraceae, which are botanically unrelated to Panax and contain hepatotoxic unsaturated pyrrolizidine alkaloids. These are metabolised to reactive pyrrolic esters that damage hepatic sinusoidal endothelium and cause sinusoidal obstruction syndrome. Tu San Qi is repeatedly reported as being misused as, or mistakenly bought as, San Qi by patients self-medicating for bruising and blood stasis, and pyrrolizidine-alkaloid-producing Gynura japonica accounts for more than half of hepatic sinusoidal obstruction syndrome cases in China. The hazard is the substitution, not any property of Panax notoginseng.
Clinical note: Source San Qi from an authenticated supply chain and check the binomial on the certificate of analysis. Ask any patient who self-sources Sanqi powder where it came from. New ascites, tender hepatomegaly, jaundice or a rising bilirubin in someone taking a Sanqi-labelled product should be treated as suspected pyrrolizidine hepatotoxicity until the material is identified.
Panax japonicus, Panax japonicus var. major and Tupistra chinensis (Kaikoujian) as substituted material
Because of the price differential, notoginseng is documented as being adulterated with marginal Panax species (Panax japonicus and Panax japonicus var. major), with starch and cassava flour, and in some Cantonese pharmacy practice with the unrelated Tupistra chinensis, sold as Chuan Sanqi, Xinbugan or Kaikoujian, which carries its own toxicity. Notoginsenoside R1 is the saponin found in Panax notoginseng but not in Panax ginseng or Panax quinquefolius, so it is the marker used to confirm identity by HPLC, NMR or DNA barcoding.
Clinical note: Require a certificate of analysis reporting notoginsenoside R1 as well as Rg1 and Rb1. A San Qi product with Rg1 and Rb1 but no R1 is a different Panax species; one with no dammarane saponins at all is not a Panax.
CYP3A4 and P-glycoprotein substrates with narrow therapeutic windows
The 2023 systematic review of notoginseng herb-drug interactions concludes that Panax notoginseng shapes the absorption, distribution, metabolism and excretion of co-administered drugs mainly by modulating cytochrome P450 enzymes and P-glycoprotein, and flags this explicitly as a red flag for drugs with a narrow therapeutic window. The amphipathic saponins additionally act as solubilising and absorption-enhancing agents, so they can raise the exposure of poorly soluble co-administered drugs by a purely physicochemical route.
Clinical note: Exercise caution with ciclosporin, tacrolimus, digoxin, antiretrovirals and oral anticancer agents. Where levels are routinely measured, measure them after starting or stopping San Qi rather than assuming stability.
Antihypertensive and antidiabetic drugs
Panax notoginseng saponins have documented vasodilatory and anti-atherosclerotic effects and the wider Panax genus is associated with modest glucose lowering. No controlled human interaction study with antihypertensives or hypoglycaemics has been published for Panax notoginseng specifically, so this is an extrapolation from pharmacology, not a demonstrated interaction.
Clinical note: Reasonable to check home blood pressure and, in insulin- or sulfonylurea-treated patients, capillary glucose during the first fortnight of use. No routine dose change is warranted.
Dosage
| Form | Amount | Frequency | Duration | Population | Notes |
|---|---|---|---|---|---|
| decoction, or powder/pills | 3–9 g | Daily | — | — | 中国药典 2020 【用法与用量】3～9g；研粉吞服，一次1～3g。外用适量。 【注意】孕妇慎用。 【性味与归经】甘、微苦，温。归肝、胃经。 — Chinese Pharmacopoeia 2020, quoted verbatim; route and cautions preserved. Replaces a cleared category-filler value. |
Dui Yao — Herb Pairs
The classical two-herb combinations this herb appears in, each with an action neither herb has alone.
The combination stops bleeding while transforming stasis, so hemorrhage is controlled without leaving clotted blood behind.
Coughing, vomiting or nosebleed of blood and bleeding with stasis; the formula also contains Xue Yu Tan.
Core pair of a classical formula — Hua Xue Dan, Yi Xue Zhong Zhong Can Xi Lu (Zhang Xichun)
Evidence Tier
Strong evidence · 5 studiesRecorded studies by study design, strongest design at the top. This is a study-design tier only, not a GRADE rating: it does not weigh risk of bias, consistency or precision.
Systematic review / meta-analysis
3
3 verified · 0 unverified
Show 3 studies
- Efficacy and safety of Panax notoginseng saponins (Xuesaitong) for patients with acute ischemic stroke: a systematic review and meta-analysis of randomized controlled trials
- Panax notoginseng preparation plus aspirin versus aspirin alone on platelet aggregation and coagulation in patients with coronary heart disease or ischemic stroke: A meta-analysis of randomized controlled trials
- Efficacy and safety of oral Panax notoginseng saponins for unstable angina patients: A meta-analysis and systematic review
Randomized controlled trial
0
Other clinical trial
0
Observational / case report
0
In vitro / animal
2
1 verified · 1 unverified
Other / unclassified
0
Verified: design read from PubMed for a DOI that resolves to the cited paper Unverified: taken from the study's recorded description
Clinical Studies
Efficacy and safety of Panax notoginseng saponins (Xuesaitong) for patients with acute ischemic stroke: a systematic review and meta-analysis of randomized controlled trials
Pooling 46 randomised trials and 7,957 patients with acute ischaemic stroke, Xuesaitong (standardised Panax notoginseng saponins) given within 14 days of onset was associated with lower modified Rankin Scale scores, higher rates of functional independence, better activities of daily living and less neurological impairment, with no significant difference in all-cause mortality or adverse event incidence versus control. The authors grade the certainty of evidence as moderate to very low and state plainly that the current evidence is too weak to be definitive, since most included trials were small and Chinese-language with unclear allocation concealment.
Panax notoginseng preparation plus aspirin versus aspirin alone on platelet aggregation and coagulation in patients with coronary heart disease or ischemic stroke: A meta-analysis of randomized controlled trials
A meta-analysis of randomised trials in coronary heart disease and ischaemic stroke found that adding a Panax notoginseng preparation to aspirin inhibited platelet aggregation more than aspirin alone (Panax notoginseng saponins WMD -6.10; panaxatriol saponins WMD -3.53), further reduced fibrinogen and D-dimer, and, for panaxatriol saponins, prolonged prothrombin time and PT-INR, with no change in platelet count. Bleeding-related events did not differ significantly between combination and aspirin alone across faecal occult blood, upper gastrointestinal bleeding, subcutaneous haemorrhage, bulbar conjunctival haemorrhage and haematuria. This is the strongest human evidence that the antiplatelet effect of San Qi is real and additive.
Efficacy and safety of oral Panax notoginseng saponins for unstable angina patients: A meta-analysis and systematic review
Seventeen randomised trials of oral Panax notoginseng saponins in unstable angina were pooled. The combined analysis reported reductions in the composite primary endpoint, improvement in electrocardiographic outcomes (RR 0.32, 95 percent CI 0.23 to 0.46), fewer and shorter angina attacks (MD -1.88) and reduced nitroglycerin consumption (MD -1.13). Adverse events were described in nine of the trials and the authors judged oral saponins safe on the evidence available, while calling for larger multicentre trials.
Effects and Mechanism of Action of Panax notoginseng Saponins on the Pharmacokinetics of Warfarin
In rats, co-administration of Panax notoginseng saponins with warfarin raised prothrombin time by 110, 122 and 126 percent and INR by 111, 124 and 128 percent at low, medium and high saponin doses respectively, reduced warfarin clearance by up to 33 percent and increased AUC by up to 134 percent. In HepG2 cells and in the animals, the saponins downregulated CYP3A4 and did not affect CYP2C9. The authors conclude the saponins enhance the anticoagulant effect of warfarin by inhibiting CYP3A4 expression. An erratum was published alongside; the paper has not been retracted.
Mechanism of Panax notoginseng saponins modulation of miR-214-3p/NR1I3 affecting the pharmacodynamics and pharmacokinetics of warfarin
Prompted by clinical observations that combining Panax notoginseng with warfarin appeared antagonistic rather than additive, the authors showed in Sprague-Dawley rats and HepG2 cells that Panax notoginseng saponins accelerated warfarin metabolism and reduced its anticoagulant effect. The saponins downregulated miR-214-3p, which binds the NR1I3 3'-UTR; loss of that repression raised NR1I3 (CAR) and CYP2C9 expression, and interfering with NR1I3 rescued the accelerated clearance. This is the mirror image of the Qian 2022 result and is why the direction of the warfarin interaction cannot be predicted.
⚠ Safety & Contraindications
- Pregnancy
- Bleeding disorders
- Before surgery
Contraindications
Its use is prohibited in pregnant women.
Source: Xi S, Gong Y. Essentials of Chinese Materia Medica and Medical Formulas. Academic Press/Elsevier, 2017, pp. 213–216.
Side Effects
- Dry mouth, high skin temperature, nervousness, insomnia; occasionally nausea and vomiting — mostly resolved without stopping except in severe cases.
- A single oral dose of 5 g may cause II degree atrioventricular block.
Source: Zhu YP. Chinese Materia Medica: Chemistry, Pharmacology and Applications. Harwood Academic, 1998, p. 423.
⚠ Rule-Based Cautions
These entries come from the deterministic rule tables that gate Verscienta's formula tools — classical pair prohibitions, pregnancy and lactation contraindications, and dose ceilings.
Pregnancy
Avoid strong blood-mover
Historical Texts
Ben Cao Gang Mu
Ming dynasty, 1578Ben Cao Gang Mu Shi Yi
Qing dynasty, 1765Yi Xue Zhong Zhong Can Xi Lu
Republican era, 1918-1934References
- Wang Ting, Guo Rixin, Zhou Guohong, Zhou Xidan, Kou Zhenzhen, Sui Feng, Li Chun, Tang Liying, Wang Zhuju. Traditional uses, botany, phytochemistry, pharmacology and toxicology of Panax notoginseng (Burk.) F.H. Chen: A review . Journal of Ethnopharmacology (2016) [DOI]
- Li Wenbiao, Shi Hailian, Wu Xiaojun. A narrative review of Panax notoginseng: Unique saponins and their pharmacological activities . Journal of Ginseng Research (2025) [DOI]
- Xie Yujuan, Wang Changhong. Herb–drug interactions between Panax notoginseng or its biologically active compounds and therapeutic drugs: A comprehensive pharmacodynamic and pharmacokinetic review . Journal of Ethnopharmacology (2023) [DOI]
- Zhu Lin, Zhang Chun-yuan, Li Dong-ping, Chen Hu-biao, Ma Jiang, Gao Hong, Ye Yang, Wang Ji-yao, Fu Peter P., Lin Ge. Tu-San-Qi (Gynura japonica): the culprit behind pyrrolizidine alkaloid-induced liver injury in China . Acta Pharmacologica Sinica (2020) [DOI]
- Ji Chao, Zhang Qin, Shi Rui, Li Juan, Wang Xingyu, Wu Zhiqiang, Ma Ying, Guo Junli, He Xiahong, Zheng Wenjie. Determination of the Authenticity and Origin of Panax Notoginseng: A Review . Journal of AOAC INTERNATIONAL (2022) [DOI]
This information is for educational purposes only and is not intended to replace professional medical advice. Always consult a qualified healthcare provider before using any herbal remedy, especially if you are pregnant, nursing, or taking medications.
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